The Assessment and Consideration about Feasibility of eFAST Exam in Medical School Students in Korea

PURPOSE: Emergency physicians usually perform ultrasound exams for patients with multiple injuries. Extended focused assessment with sonography for trauma (eFAST) can reveal injuries from chest to the abdomen immediately. However, in Korea, the curriculums of medical schools do not currently include eFAST. We have devised a study to assess the feasibility of the eFAST exam in medical school students. METHODS: This study was conducted in students in their fifth year out of six years of medical school, over 11 weeks. Four Emergency Medicine specialists trained the students over 4 hours, tested the students, and conducted a questionnaire. RESULTS: Average age of students was 25.9+/-2.6 years, and 24 were male and 20 were female. Mean success rate of 17 components on the eFAST exam was 95.9% (94.6%-97.4%). The success rate of transverse view of aorta, transverse view of bladder, lung sliding sign, and sea-shore sign of both anterior chest walls was 100%, scanning the spleen and attaching the probe to a body surface were 75%, 86.3%. Total time consumption was 449.0+/-22.2 seconds. The questionnaires showed that the eFAST exam for the splenorenal recess, spleen, and left upper quadrant lung was difficult. CONCLUSION: We found that medical students in Korea could perform the eFAST exam by themselves after 4 hours education. In the future, these findings can be helpful in development of an eFAST education program for medical students.

A clinical study of ectopic pregnancy during recent 8 years / 대한산부인과학회지

OBJECTIVE: The study was designed to ascertain a proper method of early diagnosis and treatment of ectopic pregnancy by analyzing its clinical and epidemiological characteristics. METHODS: The medical records of patients who were diagnosed to ectopic pregnancy at Hallym medical center during the period from January 1, 2000 to December 31, 2007 have been reviewed. RESULTS: The incidence of ectopic pregnancy was 7.3% (1,067) out of 14,519 deliveries. The most frequent age group was 26~30 (29.5%). Risk factors they had were previous histories of abdominal or pelvic surgery (37.0%), artificial abortion (30.8%), pelvic inflammatory disease (12%), and tubal sterilization (9.6%). Most frequent clinical symptoms were amenorrhea (88.7%), lower abdominal pain (81.2%), and vaginal spotting (60.0%). Percentage of patients with hemoglobin level over 10.0 gm/dL was 79% and below 8.0 gm/dL 3.9%. The clinical symptoms of ectopic pregnancy most commonly occurred after 6~8 weeks from last menstrual period (47%). Ectopic gestation was implanted on the fallopian tube in 89%, cornus in 7.2%, ovary in 1.1% and the cervix in 2.7%. Laparosopic surgeries were performed in 755 cases (71.6%) and laparotomies in 273 cases (25.9%) and dilatation and curettages in 26 cases (2.5%). Salpingectomy was performed most frequently (82.4%). Methotrexate (MTX) treatment was successful in 13 cases (1.21%). CONCLUSION: The early diagnosis of ectopic pregnancy is most useful when serum beta-hCG and vaginal sonography are used together. Laparoscopy would be a preferred method because of its short hospitalization period and low complication rate compared with laparotomy in ectopic pregnancy treatment.

The clinical studies on 600 cases of total laparoscopic hysterectomy (TLH) / 대한산부인과학회지

OBJECTIVE: To analyze the clinical characteristics of total laparoscopic hysterectomy. METHODS: Clinical data about 600 cases who received TLH were collected and the hospital stay, operation time and complication were evaluated. RESULTS: The most common indications for TLH were uterine myomas, adenomyosis, severe endometriosis and cervical intraepithelial neoplasia. Mean operating time was 90 minutes (range 35-200 min) and hospital stay was 3 days (range 2 days-10 days). The most important factors for the surgery time were uterine size, assistant's skill and presence of adhesions (obliteration of the cul-de-sac due to severe pelvic endometriosis). Several techniques were used, including bipolar coagulation of the ovarian and uterine vessels, and suture of the stump. A special uterine manipulator (RUMITM uterine manipulator with colpotomizer and pneumooccluder balloon) used in all procedures aided in anatomic definition and performing the circumferential colpotomy. We had two cases of ureteral obliteration by using bipolar coagulator, and 3 cases of bladder injuries during operation which was diagnosed and immediately repaired laparoscopically. We had two cases of ureterovaginal fistula, two cases of postoperative ileus and one case of bowel perforation. But there were no cases of death, thrombophlebitis or other pulmonary complications. CONCLUSIONS: Total laparoscopic hysterectomy can be performed safely and effectively when the surgical team is sufficiently trained. And we believe that total laparoscopic hysterectomy offers benefits to the patients in the form of less post-operative pain, shorter time in hospital.